膝骨性关节炎双侧同期全膝关节置换和单侧膝关节置换的比较  

Simultaneous bilateral versus unilateral total knee arthroplasty in treatment of knee osteoarthritis

作　　者：叶川[1] 刘日光[1] 汤晋[1] 李江伟[1] 张弢[2] 任厚相 孙琦[1] 吴程[1] 赵宝平[1] 

机构地区：[1]贵阳医学院附属医院骨科,贵州省贵阳市550004 [2]解放军第117医院骨科,浙江省杭州市310013

出　　处：《中国组织工程研究》2014年第35期5583-5588,共6页Chinese Journal of Tissue Engineering Research

基　　金：贵州省国际科技合作项目(黔科合外G字2010-7);贵州省科技厅社发联合基金项目(黔科合20103166);贵州省科技厅资助项目(LG2012008);贵阳医学院附属医院课题(1-2012-18)~~

摘　　要：背景:双膝重度骨性关节炎患者,选择双膝同期全膝关节置换或选择单侧全膝关节置换在安全性和临床疗效方面存在争议。目的:比较双膝重度骨性关节炎患者,双膝同期关节置换和单膝关节置换的安全性及临床疗效。方法:将拟行全膝关节置换的双膝重度骨关节炎患者60例(90膝)分为2组:单膝组(30例,30膝)行单侧全膝关节置换,双膝组(30例,60膝)行双膝同期全膝关节置换。结果与结论:2组患者在感染、肺栓塞、死亡率等并发症发生率方面差异无显著性意义(P>0.05),而双膝组患者心血管并发症的发生率、置换后失血量及输血量均高于单膝组(P<0.05)。置换后1年随访时,2组患者的膝关节活动度、股四头肌肌力、美国特种外科医院膝关节评分比较差异无显著性意义(P>0.05)。但双膝组患者目测类比评分显著低于单膝组(P<0.05),提示双侧同期全膝关节置换患者心血管并发症方面的风险略高,对存在心血管系统疾病合并症的患者,应尽量避免行双侧同期全膝关节置换。BACKGROUND：The safety and efficacy of simultaneous bilateral total knee replacement or selective unilateral total knee arthroplasty in patients with severe osteoarthritis of the knees are stil controversial. OBJECTIVE：To compare safety and clinical efficacy of patients with osteoarthritis knees after simultaneous bilateral total knee replacement or selective unilateral total knee replacement. METHODS：Total y 60 cases with severe osteoarthritis of the knees （90 knees） undergoing total knee replacement were divided into unilateral total knee replacement group （n=30, 30 knees）, and the simultaneous bilateral total knee replacement group （n=30, 60 knees）. RESULTS AND CONCLUSION：There was no significant difference in the incidence of other complications such as infection, mortality, pulmonary embolism in patients of both groups （P〉0.05）. The incidence of cardiovascular complications, postoperative blood loss and blood transfusion were higher in the bilateral knee group than in the unilateral knee group （P〈0.05）. During fol ow-up at 1 year after replacement, no significant differences in range of motion, muscle strength of quadriceps and hospital for special surgery knee score were detected in patients of both groups （P〉0.05）. However, Visual Analogue Scale scores were significantly lower in the bilateral knee group than in the unilateral group （P〈0.05）. These data indicated that the risk of cardiovascular complications was high in patients receiving bilateral total knee replacement. Patients with severe cardiovascular disease should avoid simultaneous bilateral total knee arthroplasty.

关 键 词：植入物 人工假体 全膝关节置换 双膝置换 单膝置换 膝关节 骨性关节炎 心血管 安全性 临床疗效 并发症 

分 类 号：R318[医药卫生—生物医学工程]